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myBenefits Card Registration Form

The myBenefits Card is an important piece of identification that will ease access to your benefits. All eligible students must complete the myBenefits Card Registration Form. This multi-purpose card provides your policy information for submission of claims at both the Pharmacy and the Dental Office.
To obtain your myBenefits Card you must first register for BC Fair Pharmacare.

Downloading the myBenefits Card does not confirm eligibility or benefits coverage. Please contact the CCSS Member Services to confirm your enrolment in the plan.

Please send an electronic version of myBenefits Card to the email address provide aboveI will pick up my Benefits Card on Campus

Enrolment in the Student Health and Dental plan not guaranteed by submitting this form. The Student must be eligible for the program. Should you have any questions regarding the enrolment process please contact CCSS Member Services prior to submitting this form.

I understand the information provided above is required in order to obtain the said pay direct drug card. I hereby authorize and consent to the use, release, and exchange of the above information between the institution, the student organization, the Student Service Co-ordinator, Gallivan & Associates, BCE Emergis Assure Health Division, and the insurance carrier(s) to be used solely in connection with the Student Benefits Plan. I confirm that all the information provided herein is accurate. I also understand that the Student Service Coordinator may need to notify the institution to find out whether or not I have paid for the plan.